New audit report - O RhD negative red blood cells (RBCs)

The Victorian Blood Matters program recently released findings from the 2024 audit on ‘The indications for the use of group O RhD negative red blood cells’.   

The aim was to assess the use of O RhD negative red blood cells (RBCs) against Australian guidance and compare this with their 2017 audit.  

To assess the impact of the 2023 National Statement for the Emergency Use of Group O Red Cells, the 2017 data was reanalysed to identify changes in practice following its release.  

Their 2024 audit comprised of two components: Part 1: O RhD negative policy and inventory and Part 2: O RhD negative RBC usage.   

Significant opportunities to improve the alignment of policy with local practice were identified, with the report outlining a range of recommendations.   

Overall, the audit found that Victorian health services and laboratories have policies in place that support the guidelines and recommendations for the responsible use and stewardship of O RhD negative RBC. However, much of O RhD negative RBC use remained outside guidelines and was largely utilised for inventory management, with little change since 2017.  

More about the audit 

• During the audit period (March 2024), Victorian health services submitted data on 2,827 RBC units, including 99 paediatric RBC packs. Of these, 254 were excluded. 
• The findings indicated that most health services had policies that were reflective of the current guidance (to transfuse the same ABO and RhD group as the patient where possible). 
• A third (n=29) of health services/transfusion laboratories stocked only O RhD negative RBC units (between 2 - 6 units). This was an increase from the 2017 audit where 24% held only O RhD negative RBC inventory.
• 84 Victorian health services reported the fate (transfused, discarded or rotated) of at least one O RhD negative RBC issued during March 2024. 
• Approximately 40% (898/2,220) of all O RhD negative RBC units issued during March 2024 were transfused to O RhD negative patients whilst 3% (73/2,220) of all O RhD negative RBC units issued were transfused in an emergency to patients with an unknown blood group, in accordance with current guidelines.
• A total of 38 health services reported issuing emergency use O RhD negative RBCs to females over 50 years and adult males over 18 years, with unknown blood group. Approximately 9% (n=208) of O RhD negative RBC units were selected contrary to the National Statement for the Emergency Use of Group O Red Blood Cells. 
• When compared to the 2017 audit results, 9 health services reported discarding 51 (2.2%) O RhD negative RBC units as opposed to 88 (4%) in 2017. Discards due to ‘Other’ reasons included clinical, damage and transportation causes. 
• The results from the audit also showed 41% of O RhD negative RBC use remained outside guidelines. 

  These findings highlight opportunities for health services to better align their practices with current guidelines. 

•   Blood Matters program. The indications for the use of O RhD negative red blood cells audit report 2024. ISBN 978-1-76131-740-8. https://www.health.vic.gov.au/patient-care/blood-matters-audit-reports#2024